两种长效GnRH⁃a在降调节方案冻融胚胎移植周期准备内膜的临床疗效比较
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国家自然科学基金(81971386)


Comparison of clinical efficacy of two long⁃acting gonadotropin⁃releasing hormone agonists in down⁃regulation combined with hormone replacement cycle of frozen⁃thawed embryo transfer
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    摘要:

    目的:比较两种长效促性腺激素释放激素激动剂(gonadotropin-releasing hormone agonist,GnRH-a)在降调节联合激素替代周期冻融胚胎移植(frozen embryo transfer,FET)中的临床疗效。方法:回顾性队列研究分析2019年11月1日—2021年1月31日期间在南京医科大学附属妇产医院生殖医学中心采用2种不同的长效GnRH-a准备内膜的冻融囊胚移植周期共462周期,其中曲普瑞林组324周期,亮丙瑞林组138周期。通过Logistic回归模型分析2种长效GnRH-a与FET临床疗效的关系。结果:亮丙瑞林组雌激素启动日LH[(2.70±1.28)mU/ml]高于曲普瑞林组[(2.41±1.19)mU/mL,P=0.017];亮丙瑞林组种植率(62.6%)高于曲普瑞林组(54.6%),差异有统计学意义(P=0.044),临床妊娠率相对于曲普瑞林组有升高趋势,但差异无统计学意义(P=0.334),早期流产率较曲普瑞林组有下降趋势,但差异也无统计学意义(P=0.490)。在Logistic回归模型中,校正包括年龄、移植囊胚数、优质囊胚数、雌激素启动日LH水平、内膜厚度在内的混杂因素后,亮丙瑞林组相对于曲普瑞林组临床妊娠率的校正OR值为1.493(95%CI=0.932~2.392,P=0.095)。结论:在降调节激素替代FET中,亮丙瑞林和曲普瑞林均可达到满意的降调效果,亮丙瑞林可提高囊胚的种植率,并获得与曲普瑞林相似的临床结局。

    Abstract:

    Objective:This study aims to compare the clinical efficacy of two long-acting gonadotropin-releasing hormone agonists(GnRH-a)in down-regulation combined with hormone replacement cycle frozen-thawed embryo transfer(FET). Methods:A retrospective cohort study of 462 frozen-thawed blastocyst transfer cycles using two different long-acting GnRH-a for endometrial preparation was performed at the Department of Reproductive Medicine,the Affiliated Obstetrics and Gynaecology Hospital of Nanjing Medical University from November 1,2019 to January 31,2021,including 324 cycles in the triptorelin group and 138 cycles in the leuprorelin group. Logistic regression model was used to analyze the relationship between two long-acting GnRH-a and the clinical efficacy of frozen-thawed blastocyst transfer. Results:The level of LH[(2.70±1.28)mU/mL]on estrogen initiation day was higher than that in triptorelin group[(2.41±1.19)mU/ mL],P=0.017];The implantation rate of leuprorelin group(62.6%)was higher than that of triptorelin group(54.6%),and the difference was statistically significant(P=0.044);the clinical pregnancy rate was increased compared with the triptorelin group,but the difference was not statistically significant(P=0.334),and the early abortion rate was decreased compared with the triptorelin group,but the difference was not statistically significant(P=0.490). In the logistic regression model,after adjusting for confounding factors including age,number of blastocyst,number of good-quality blastocyst,the level of LH on estrogen initiation day and endometrium thickness,the adjusted OR value of clinical pregnancy rate in leuprorelin group versus triptorelin group was 1.493(95% CI= 0.932~2.392,P=0.095). Conclusion:In the down-regulation combined with hormone replacement cycle of FET,both leuprorelin and triptorelin can achieve satisfactory down-regulation effect. Leuprorelin can improve the blastocyst implantation rate,and obtain similar clinical outcomes with triptorelin.

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张 娟,周羽西,张娟娟,李 欣,张媔秋,苏 雁,凌秀凤,赵 纯.两种长效GnRH⁃a在降调节方案冻融胚胎移植周期准备内膜的临床疗效比较[J].南京医科大学学报(自然科学版),2022,42(2):206-210

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  • 收稿日期:2021-10-29
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  • 在线发布日期: 2022-03-01
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